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CHAPTER 4Shifting to a Systemic Perspective

Heart disease is the number-one cause of death for women in the United States. While men are more likely to be diagnosed with the condition, women account for more than half of the fatalities. Even though women are more likely to die from heart disease, doctors are less likely to recommend tests for them that would diagnose it.

This disconnect doesn't come from bad intentions. Doctors do not care less about women having heart attacks. The biases that leave women untreated aren't personal—they're systemic.

For centuries, heart disease was synonymous with chest pain. Only recently did the medical community confirm that chest pain is the way heart attacks commonly present in men. Symptoms are different for women. They often include discomfort in the neck, jaw, back, or arm, and nausea or feelings of indigestion. For decades these symptoms weren't recognized as a heart attack, and women were sent home with misdiagnoses of heartburn or stomach ulcers. These women didn't receive the care that would typically aid recovery and healing following a heart attack and in turn were more likely than men to die within a year.

This tragic gap in treatment is a failure of design—research design, specifically. In landmark studies on heart disease from the 1970s, only middle-aged men were the research subjects. The study most often cited for establishing a link between cholesterol and heart disease included 12,866 men and no women. The Harvard Physician's ...